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Leenaerts N, Jongen D, Ceccarini J, Van Oudenhove L, Vrieze E. The neurobiological reward system and binge eating: A critical systematic review of neuroimaging studies. Int J Eat Disord 2022; 55:1421-1458. [PMID: 35841198 DOI: 10.1002/eat.23776] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Changes in reward processing are hypothesized to play a role in the onset and maintenance of binge eating (BE). However, despite an increasing number of studies investigating the neurobiological reward system in individuals who binge eat, no comprehensive systematic review exists on this topic. Therefore, this review has the following objectives: (1) identify structural and functional changes in the brain reward system, either during rest or while performing a task; and (2) formulate directions for future research. METHODS A search was conducted of articles published until March 31, 2022. Neuroimaging studies were eligible if they wanted to study the reward system and included a group of individuals who binge eat together with a comparator group. Their results were summarized in a narrative synthesis. RESULTS A total of 58 articles were included. At rest, individuals who binge eat displayed a lower striatal dopamine release, a change in the volume of the striatum, frontal cortex, and insula, as well as a lower frontostriatal connectivity. While performing a task, there was a higher activity of the brain reward system when anticipating or receiving food, more model-free reinforcement learning, and more habitual behavior. Most studies only included one patient group, used general reward-related measures, and did not evaluate the impact of comorbidities, illness duration, race, or sex. DISCUSSION Confirming previous hypotheses, this review finds structural and functional changes in the neurobiological reward system in BE. Future studies should compare disorders, use measures that are specific to BE, and investigate the impact of confounding factors. PUBLIC SIGNIFICANCE STATEMENT This systematic review finds that individuals who binge eat display structural and functional changes in the brain reward system. These changes could be related to a higher sensitivity to food, relying more on previous experiences when making decisions, and more habitual behavior. Future studies should use a task that is specific to binge eating, look across different patient groups, and investigate the impact of comorbidities, illness duration, race, and sex.
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Affiliation(s)
- Nicolas Leenaerts
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Daniëlle Jongen
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Jenny Ceccarini
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Laboratory, Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Elske Vrieze
- Mind-body Research, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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DAT1 and Its Psychological Correlates in Children with Avoidant/Restrictive Food Intake Disorder: A Cross-Sectional Pilot Study. Behav Sci (Basel) 2021; 11:bs11010009. [PMID: 33466618 PMCID: PMC7828669 DOI: 10.3390/bs11010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/03/2021] [Accepted: 01/09/2021] [Indexed: 12/02/2022] Open
Abstract
International research has underlined the role played by children’s and maternal psychopathological symptoms on the onset of avoidant/restrictive food intake disorder (ARFID) in early childhood. No study has considered the possible interplay between children’s dopamine transporter (DAT1) genotype and methylation, dysregulation problems and maternal psychopathological risk. This study aimed to investigate the complex relationship between these variables, considering the possible mediation role played by children’s DAT1 methylation on the relationship between mothers’ psychopathological risk and children’s dysregulation problems, moderated by children’s DAT1 genotype. Our sample consisted of 94 early children and their mothers, divided into four subgroups, based on children’s ARFID subtypes (irritable/impulsive (I/I), sensory food aversions (SFA), post-traumatic feeding disorders subtypes (PTFD), and a non-clinical group (NC)). We addressed children’s dysregulation problems and maternal psychopathological risk, and collected children’s DNA through buccal swabs. Results showed that children’s 9/x genotype was associated with PTFD and NC groups, whereas the 10/10 genotype was associated with the SFA group, with large effect size. There were significant large differences in the study groups on children’s DAT1 total methylation, children’s dysregulation problems, and maternal psychopathological risk. Children’s DAT1 methylation did not mediate the relationship between mother’s psychopathological risk and children’s dysregulation problems, but there was a significant large direct effect. Children’s 9/x genotype moderated the relationship between maternal psychopathological risk and children’s DAT1 methylation but, respectively, with a large and small effect. Our pilot study suggested that the relationship between children’s DAT1 genotype and methylation, dysregulation problems, and maternal psychopathological risk has a crucial contribution to ARFID.
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Mele G, Alfano V, Cotugno A, Longarzo M. A broad-spectrum review on multimodal neuroimaging in bulimia nervosa and binge eating disorder. Appetite 2020; 151:104712. [DOI: 10.1016/j.appet.2020.104712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/25/2020] [Accepted: 04/09/2020] [Indexed: 12/17/2022]
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Babbs RK, Beierle JA, Yao EJ, Kelliher JC, Medeiros AR, Anandakumar J, Shah AA, Chen MM, Johnson WE, Bryant CD. The effect of the demyelinating agent cuprizone on binge-like eating of sweetened palatable food in female and male C57BL/6 substrains. Appetite 2020; 150:104678. [PMID: 32209386 DOI: 10.1016/j.appet.2020.104678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
Binge eating is a heritable symptom of eating disorders with an unknown genetic etiology. Rodent models for binge-like eating (BLE) of palatable food permit the study of genetic and biological mechanisms. We previously genetically mapped a coding mutation in Cyfip2 associated with increased BLE of sweetened palatable food in the C57BL/6NJ versus C57BL/6J substrain. The increase in BLE in C57BL/6NJ mice was associated with a decrease in transcription of genes enriched for myelination in the striatum. Here, we tested the hypothesis that decreasing myelin levels with the demyelinating agent cuprizone would enhance BLE. Mice were treated with a 0.3% cuprizone home cage diet for two weeks. Cuprizone induced similar weight loss in both substrains and sexes that recovered within 48 h after removal of cuprizone. Following a three-week recovery period, mice were trained for BLE in an intermittent, limited access procedure. Surprisingly, cuprizone significantly reduced BLE in male but not female C57BL/6NJ mice while having no effect in C57BL/6J mice. Cuprizone also reduced myelin basic protein (MBP) at seven weeks post-cuprizone removal while having no effect on myelin-associated glycoprotein at this time point. C57BL/6NJ mice also showed less MBP than C57BL/6J mice. There were no statistical interactions of Treatment with Sex on MBP levels, indicating that differences in MBP reduction are unlikely to account for sex differences in BLE. To summarize, cuprizone induced an unexpected, significant reduction in BLE in C57BL/6NJ males, which could indicate genotype-dependent sex differences in the biological mechanisms of BLE.
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Affiliation(s)
- Richard K Babbs
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA
| | - Jacob A Beierle
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA; Biomolecular Pharmacology Ph.D. Program, Boston University School of Medicine, USA; Boston University's Transformative Training Program in Addiction Science (TTPAS), Biomedical Genetics, Boston University School of Medicine, 72 E. Concord St., E-200, Boston, MA, 02118, USA
| | - Emily J Yao
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA
| | - Julia C Kelliher
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA
| | - Arthurine R Medeiros
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA; National Institute on Drug Abuse Diversity Scholars Program, 6001 Executive Boulevard, Room 3105, MSC 9567, Bethesda, MD, USA, 20892-9567
| | - Jeya Anandakumar
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA; National Institute on Drug Abuse Diversity Scholars Program, 6001 Executive Boulevard, Room 3105, MSC 9567, Bethesda, MD, USA, 20892-9567
| | - Anyaa A Shah
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA
| | - Melanie M Chen
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA
| | - William E Johnson
- Department of Medicine, Division of Computational Biomedicine, Boston University, 72 E. Concord St., E-609, Boston, MA, 02118, USA
| | - Camron D Bryant
- Laboratory of Addiction Genetics, Department of Pharmacology and Experimental Therapeutics and Psychiatry, Boston University School of Medicine, 72 E. Concord St., L-606C, Boston, MA, 02118, USA.
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Latorre E, Mesonero JE, Harries LW. Alternative splicing in serotonergic system: Implications in neuropsychiatric disorders. J Psychopharmacol 2019; 33:1352-1363. [PMID: 31210090 DOI: 10.1177/0269881119856546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The serotonergic system is a key component of physiological brain function and is essential for proper neurological activity. Numerous neuropsychiatric disorders are associated with deregulation of the serotonergic system. Accordingly, many pharmacological treatments are focused on modulation of this system. While providing a promising line of therapeutic moderation, these approaches may be complicated due to the presence of alternative splicing events for key genes in this pathway. Alternative splicing is a co-transcriptional process by which different mRNA transcripts can be produced from the same gene. These different isoforms may have diverse activities and functions, and their relative balance is often critical for the maintenance of homeostasis. Alternative splicing greatly increases the production of proteins, augmenting cell plasticity, and provides an important control point for regulation of gene expression. AIM The objective of this narrative review is to discuss the potential impact of alternative splicing of different components of the serotonergic system and speculate on their involvement in several neuropsychiatric disorders. CONCLUSIONS The specific role of each isoform in disease and their relative activities in the signalling pathways involved are yet to be determined. We need to gain a better understanding of the basis of alternative isoforms of the serotonergic system in order to fully understand their impact and be able to develop new effective pharmacological isoform-specific targets.
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Affiliation(s)
- Eva Latorre
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
- Instituto Agroalimentario de Aragón - IA2 (Universidad de Zaragoza - CITA), Zaragoza, Spain
| | - Jose Emilio Mesonero
- Instituto Agroalimentario de Aragón - IA2 (Universidad de Zaragoza - CITA), Zaragoza, Spain
- Departamento Farmacología y Fisiología, Facultad de Veterinaria, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain
| | - Lorna W Harries
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Exeter, UK
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McDonald S. Understanding the genetics and epigenetics of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD): a systematic review. Eat Weight Disord 2019; 24:799-814. [PMID: 31119586 PMCID: PMC6751148 DOI: 10.1007/s40519-019-00688-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/08/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate and understand the genetic and epigenetic basis of bulimia nervosa/bulimia spectrum disorder and comorbid borderline personality disorder (BN/BSD-BPD). METHODS The present systematic review was conducted in accordance to PRISMA guidelines. Advanced systematic searches of Medline, EMBASE, PsychINFO, Web of Science, Scopus, CINHAL plus, and the Cochrane Library were conducted using the search terms 'bulimia nervosa', 'bulimia spectrum disorder', 'borderline personality disorder', 'genes', and 'genetics'. The search strategy garnered seven studies for inclusion in the present review. RESULTS Women with BN/BSD-BPD had significantly lower serotonin and monoamine oxidise activity compared to women with BN/BSD or healthy controls (HC). As well, women with BN/BSD-BPD displayed elevated methylation of the dopamine receptor gene promoter, brain-derived neurotrophic factor, and changes in the methylation of the glucocorticoid receptor gene promoter (NR3C1) compared to women with BN/BSD and HC. The results also demonstrated that rates of childhood sexual abuse and childhood physical abuse are higher in those with BN/BSD-BPD than those with BN/BSD and HC, and that these types of abuse are often correlated with the methylation differences seen in BN/BSD-BPD women. CONCLUSION Due to the differences observed between individuals with BN/BSD-BPD and those with BN/BSD and HC a genetic/epigenetic aetiological model of BN/BSD-BPD was developed and is proposed in this review. This evidence-based model visually illustrates the current state of the field and draws attention to the need for subsequent research.
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Affiliation(s)
- Sydney McDonald
- Division of Medicine, University College London, Gower Street, London, WC1E 6BT, UK.
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Hudon Thibeault AA, Sanderson JT, Vaillancourt C. Serotonin-estrogen interactions: What can we learn from pregnancy? Biochimie 2019; 161:88-108. [PMID: 30946949 DOI: 10.1016/j.biochi.2019.03.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
We have reviewed the scientific literature related to four diseases in which to serotonin (5-HT) is involved in the etiology, herein named 5-HT-linked diseases, and whose prevalence is influenced by estrogenic status: depression, migraine, irritable bowel syndrome and eating disorders. These diseases all have in common a sex-dimorphic prevalence, with women more frequently affected than men. The co-occurrence between these 5-HT-linked diseases suggests that they have common physiopathological mechanisms. In most 5-HT-linked diseases (except for anorexia nervosa and irritable bowel syndrome), a decrease in the serotonergic tone is observed and estrogens are thought to contribute to the improvement of symptoms by stimulating the serotonergic system. Human pregnancy is characterized by a unique 5-HT and estrogen synthesis by the placenta. Pregnancy-specific disorders, such as hyperemesis gravidarum, gestational diabetes mellitus and pre-eclampsia, are associated with a hyperserotonergic state and decreased estrogen levels. Fetal programming of 5-HT-linked diseases is a complex phenomenon that involves notably fetal-sex differences, which suggest the implication of sex steroids. From a mechanistic point of view, we hypothesize that estrogens regulate the serotonergic system, resulting in a protective effect against 5-HT-linked diseases, but that, in turn, 5-HT affects estrogen synthesis in an attempt to retrieve homeostasis. These two processes (5-HT and estrogen biosynthesis) are crucial for successful pregnancy outcomes, and thus, a disruption of this 5-HT-estrogen relationship may explain pregnancy-specific pathologies or pregnancy complications associated with 5-HT-linked diseases.
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Affiliation(s)
- Andrée-Anne Hudon Thibeault
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
| | - J Thomas Sanderson
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada.
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
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Nicoletti CF, Delfino HBP, Ferreira FC, Pinhel MADS, Nonino CB. Role of eating disorders-related polymorphisms in obesity pathophysiology. Rev Endocr Metab Disord 2019; 20:115-125. [PMID: 30924001 DOI: 10.1007/s11154-019-09489-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human biological system provides innumerable neuroendocrine inputs for food intake control, with effects on appetite's modulation and the satiety signs. Its regulation is very complex, engaging several molecular interactions with many tissues, hormones, and neural circuits. Thus, signaling molecules that control food intake are critical for normal energy homeostasis and a deregulation of these pathways can lead to eating disorders and obesity. In line of this, genetic factors have a significantly influence of the regulation of neural circuits controlling the appetite and satiety pathways, as well as the regulation of brain reward systems. Single Nucleotide Polymorphisms (SNPs) in genes related to hypothalamic appetite and satiety mechanisms, further in multiple neurotransmitter systems may contribute to the development of major Eating Disorders (EDs) related to obesity, among them Binge Eating Disorder (BED) and Bulimia Nervosa (BN), which are discussed in this review.
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Affiliation(s)
- Carolina Ferreira Nicoletti
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Flávia Campos Ferreira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Laboratory of Studies in Biochemistry and Molecular Biology, Department of Molecular Biology, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Carla Barbosa Nonino
- Department of Health Sciences, Ribeirão Preto Medical School - FMRP/USP - Laboratory of Nutrigenomic Studies, University of São Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14049-900, Brazil.
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Abstract
Anorexia nervosa and bulimia nervosa are characterized by severely restricted intake, binge eating, and compensatory behaviors like self-induced vomiting. The neurobiological underpinnings of these maladaptive behaviors are poorly understood, but the application of cognitive neuroscience and neuroimaging to eating disorders has begun to elucidate their pathophysiology. Specifically, this review focuses on 3 areas that suggest paths forward: reward, cognitive and behavioral control, and decision making. Understanding the brain-based mechanisms that promote and maintain these often chronic symptoms could guide the development of new and more effective treatments.
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Taylor O, Audenaert K, Baeken C, Saunders J, Peremans K. Nuclear medicine for the investigation of canine behavioral disorders. J Vet Behav 2016. [DOI: 10.1016/j.jveb.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Over the past decade, brain imaging has helped to better define eating disorder-related brain circuitry. Brain research on gray matter (GM) and white matter (WM) volumes had been inconsistent, possibly due to the effects of acute starvation, exercise, medication, and comorbidity, but newer studies have controlled for such effects. Those studies suggest larger left medial orbitofrontal gyrus rectus volume in ill adult and adolescent anorexia nervosa after recovery from anorexia nervosa, and in adult bulimia nervosa. The orbitofrontal cortex is important in terminating food intake, and altered function could contribute to self-starvation. The right insula, which processes taste but also interoception, was enlarged in ill adult and adolescent anorexia nervosa, as well as adults recovered from the illness. The fixed perception of being fat in anorexia nervosa could be related to altered insula function. A few studies investigated WM integrity, with the most consistent finding of reduced fornix integrity in anorexia and bulimia nervosa-a limbic pathway that is important in emotion but also food intake regulation. Functional brain imaging using basic sweet taste stimuli in eating disorders during the ill state or after recovery implicated repeatedly reward pathways, including insula and striatum. Brain imaging that targeted dopamine-related brain activity using taste-reward conditioning tasks suggested that this circuitry is hypersensitive in anorexia nervosa, but hyporesponsive in bulimia nervosa and obesity. Those results are in line with basic research and suggest adaptive reward system changes in the human brain in response to extremes of food intake-changes that could interfere with normalization of eating behavior.
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Affiliation(s)
- Guido K W Frank
- Departments of Psychiatry and Neuroscience,University of Colorado Anschutz Medical Campus,Children's Hospital Colorado,Aurora,Colorado,USA
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Spies M, Knudsen GM, Lanzenberger R, Kasper S. The serotonin transporter in psychiatric disorders: insights from PET imaging. Lancet Psychiatry 2015; 2:743-755. [PMID: 26249305 DOI: 10.1016/s2215-0366(15)00232-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 01/09/2023]
Abstract
Over the past 20 years, psychotropics affecting the serotonergic system have been used extensively in the treatment of psychiatric disorders. Molecular imaging, in particular PET, has allowed for elucidation of the essential contribution of the serotonin transporter to the pathophysiology of various psychiatric disorders and their treatment. We review studies that use PET to measure cerebral serotonin transporter activity in psychiatric disorders, focusing on major depressive disorder and antidepressant treatment. We also discuss opportunities and limitations in the application of this neuroimaging method in clinical practice. Although results from individual studies diverge, meta-analysis indicates a trend towards reduced serotonin transporter availability in patients with major depressive disorder. Inconsistencies in results might suggest symptom heterogeneity in major depressive disorder and might therefore be relevant for stratification of patients into clinical subsets. PET has enabled the elucidation of mechanisms of response to selective serotonin reuptake inhibitors (SSRIs) and hence provides a basis for rational pharmacological treatment of major depressive disorder. Such imaging studies have also suggested that the pattern of serotonin transporter binding before treatment might predict response to antidepressant treatment, which could potentially be clinically useful in the future. Additionally, this Review discusses PET studies investigating the serotonin transporter in anxiety, obsessive-compulsive disorder, and eating disorders. Few studies have shown changes in serotonin transporter activity in schizophrenia and attention deficit hyperactivity disorder. By showing the scarcity of data in these psychiatric disorders, we highlight the potential for further investigation in this field.
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Affiliation(s)
- Marie Spies
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gitte M Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
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von Hausswolff-Juhlin Y, Brooks SJ, Larsson M. The neurobiology of eating disorders--a clinical perspective. Acta Psychiatr Scand 2015; 131:244-55. [PMID: 25223374 DOI: 10.1111/acps.12335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a neurobiological basis of eating disorders for clinicians and to enlighten how comparing neurobiology and eating disorders with neurobiology of other psychiatric illnesses can improve treatment protocols. METHOD A selective review on the neurobiology of eating disorders. The article focuses on clinical research on humans with consideration of the anatomical, neural, and molecular basis of eating disorders. RESULTS The neurobiology of people with eating disorders is altered. Many of the neurobiological regions, receptors, and chemical substrates that are affected in other mental illnesses also play an important role in eating disorders. More knowledge about the neurobiological overlap between eating disorders and other psychiatric populations will help when developing treatment protocols not the least regarding that comorbidity is common in patients with EDs. CONCLUSION Knowledge about the underlying neurobiology of eating disorders will improve treatment intervention and will benefit from comparisons with other mental illnesses and their treatments.
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Affiliation(s)
- Y von Hausswolff-Juhlin
- Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm, Sweden
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Galusca B, Sigaud T, Costes N, Redoute J, Massoubre C, Estour B. Wide impairment of cerebral serotoninergic activity but inter-individual heterogeneity in bulimia nervosa patients: a pilot [(18)F]MPPF/PET study. World J Biol Psychiatry 2014; 15:599-608. [PMID: 25054914 DOI: 10.3109/15622975.2014.942358] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Bulimia nervosa (BN) is associated with abnormalities of serotoninergic system. Functional or ligand specific brain imaging studies revealed abnormalities in non-overlapping regions. [(18)F]MPPF (4-(2-methoxyphenyl)-1-[2-(N-2-pyridinyl)-p-fluorobenzamido]-ethylpiperazine) is a selective 5-HT1A receptor antagonist with a serotonin-like affinity, capable to assess changes of brain serotoninergic activity in BN patients. METHODS [(18)F]MPPF cerebral binding potential (BPND) was measured by positron emission tomography scan in nine purging-type BN patients and eleven age-matched controls. Voxel-based statistical parametric mapping (SPM) analyses were performed to assess BPND differences between the two groups and between each BN patient and controls group. RESULTS Mean [(18)F]MPPF BPND was overall increased in BN patients. SPM analysis with revealed symmetrical large clusters of increased [(18)F]MPPF binding in insula, temporo-parietal cortex, prefrontal cortex, in limbic, paralimbic cortex and raphe nuclei. SPM individual analysis indicated significant heterogeneity of [(18)F]MPPF mapping within BN group, including cases with isolated up to widespread increased binding. [(18)F]MPPF BPND did not covariate with depression or eating behaviour-related scores. CONCLUSIONS Large clusters of increased [(18)F]MPPF binding in severe BN overlap previous results, separately described within fMRI or PET studies. The relationship between the inter-individual [(18)F]MPPF binding heterogeneity and serotoninergic modulators efficacy in these patients remains to be assessed.
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Rybakowski JK, Kaminska K, Charytonik J, Akiskal KK, Akiskal HS. Temperamental dimensions of the TEMPS-A in females with co-morbid bipolar disorder and bulimia. J Affect Disord 2014; 164:90-3. [PMID: 24856559 DOI: 10.1016/j.jad.2014.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/09/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We investigated the effect of co-morbid bipolar disorder and bulimia on temperamental dimensions measured by TEMPS-A, relative to "pure" bulimia and "pure" bipolar disorder, in female patients. METHODS The study was performed on 47 patients with bipolar disorder (BD) with a mean age of 36±10 years, 96 patients with bulimia or bulimic type of anorexia, mean age 26±9 years and 50 control healthy females (HC), mean age 29±6 years. Among bulimic patients, a group of 68 subjects with co-morbid bulimia with bipolarity (BD+B) was identified, based on positive score of the Mood Disorder Questionnaire (MDQ). The TEMPS-A questionnaire, 110 questions version, has been used, evaluating five temperament domains: depressive, cyclothymic, hyperthymic, irritable and anxious. Parametric analysis was performed for 4 groups (BD, "pure" bulimia (PB), BD+B and HC), with 28 subjects randomly chosen from each group, using analysis of variance and cluster analysis. RESULTS All clinical groups significantly differed from control group by having higher scores of depressive, cyclothymic, irritable and anxious temperaments and lower of hyperthymic one. Among patients, significantly higher scores of cyclothymic and irritable temperaments were found in BD+B compared to both PB and BD. These differences were also reflected in cluster analysis, where two clusters were identified. LIMITATIONS Bipolarity in bulimic patients assessed only by the MDQ. CONCLUSIONS These results show that co-morbid bulimia and bipolar disorder is characterized by extreme dimensions of both cyclothymic and irritable temperaments, significantly higher than each single diagnosis. Possible clinical implications of such fact are discussed.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572 Poznan, Poland.
| | - Katarzyna Kaminska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572 Poznan, Poland
| | | | - Kareen K Akiskal
- International Mood Center, Paris, France; International Mood Center, La Jolla, CA, USA
| | - Hagop S Akiskal
- International Mood Center, Paris, France; International Mood Center, La Jolla, CA, USA
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16
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Juckel G. Serotonin: from sensory processing to schizophrenia using an electrophysiological method. Behav Brain Res 2014; 277:121-4. [PMID: 24971690 DOI: 10.1016/j.bbr.2014.05.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/18/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Serotonin plays a major role in sensory processing especially with in the primary auditory cortex. The so-called loudness dependence of auditory evoked potentials is generated by pyramidal cells of the primary auditory cortex (LDAEP) which are modulated by serotonergic projection fibers to the main regulators of pyramidal cells, i.e. GABAergic interneurons. Therefore, there are a lot of preclinical as well as clinical proofs and hints that the LDAEP may serve as a valid indicator of synaptically released serotonin, although there are also data not supporting this relationship. This is further examplified by LDAEP data in patients with different states of schizophrenia, from prodromal to the chronic state. Hereby, a strong relationship was found between LDAEP, i.e. different serotonin levels, and the negative symptoms of these groups of patients with schizophrenia. This underlines the importance of LDAEP as indicator of central serotonergic neurotransmission and its high relevance for clinical psychiatry and psychopharmacology.
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Affiliation(s)
- Georg Juckel
- Dept. of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstr.1, 44791 Bochum, NRW, Germany.
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Abstract
Over the past decade, considerable advances have been made in understanding genetic influences on eating pathology. Eating disorders aggregate in families, and twin studies reveal that additive genetic factors account for approximately 40% to 60% of liability to anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Molecular genetics studies have been undertaken to identify alterations in deoxyribonucleic acid sequence and/or gene expression that may be involved in the pathogenesis of disordered eating behaviors, symptoms, and related disorders and to uncover potential genetic variants that may contribute to variability of treatment response. This article provides an in-depth review of the scientific literature on the genetics of AN, BN, and BED including extant studies, emerging hypotheses, future directions, and clinical implications.
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Affiliation(s)
- Sara E Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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18
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Abstract
Neuroanatomical and functional studies in the eating disorders (ED) are reviewed. Typically, anorexia nervosa (AN) is associated with cerebral spinal fluid spaces enlargement which generally recover as a function of re-feeding. However, specific cortical areas fail to correct in weight restored anorectic patients suggesting trait-related abnormalities. Functional changes in AN associated with starvation reverse with weight recovery, however, reduced 5-HT2A receptor binding may be fundamental to the pathophysiology of AN since this remains after long term weight restoration. Structural studies of bulimia nervosa (BN) provide evidence of brain atrophy, in the absence of significant weight loss but potentially related to chronic dietary restriction. Functional investigations reveal reduced thalamic and hypothalamic serotonin transporter availability in BN which increases with longer illness duration. Thus, BN is associated with substantial structural and functional alterations despite normal weight. Recent advances in neuroimaging techniques and their interpretation are increasing our understanding of normal processes in the control of food intake including neuroanatomical correlates of hunger and satiety. Taken together with the structural and functional changes observed in the ED, neuroimaging provides a powerful platform to identify the underlying trait-related pathophysiological mechanisms in the aetiology and maintenance of AN and BN.
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Affiliation(s)
- Emmanuel A Stamatakis
- Department of Experimental Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK.
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19
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Wallmeier D, Winkler JK, Fleming T, Woehning A, Huennemeyer K, Roeder E, Nawroth PP, Friederich HC, Wolfrum C, Schultz JH, Rudofsky G. Genetic modulation of the serotonergic pathway: influence on weight reduction and weight maintenance. GENES & NUTRITION 2013; 8:601-610. [PMID: 23797338 PMCID: PMC3824832 DOI: 10.1007/s12263-013-0350-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
The serotonergic pathway plays a major role in the development of obesity. Its activity can be modulated by the 5-HT transporter-linked polymorphic region in the SLC6A4 gene and the upstream variable number of tandem repeats polymorphism in the MAOA gene. We studied whether these genetic modulations have an influence on weight reduction and weight maintenance in a one-year weight reduction program (OPTIFAST®52). The polymorphisms were genotyped by PCR in a sample of 135 female and 67 male subjects with severe obesity (44 ± 13 years, 122.3 ± 22.2 kg, BMI: 41.7 ± 6.7 kg/m2). The program leads to a total weight loss of 19.9 ± 9.8 kg (16.9 ± 8.3 %) in women and 27.4 ± 13.6 kg (20.4 ± 9.9 %) in men. Anthropometric measurements and blood levels were determined at the start of the program (T0), after the weight reduction phase (T1) and after the subsequent weight maintenance phase at the end of the program (T2). Each polymorphism alone did not significantly influence weight loss or weight maintenance neither in men nor in women. However, women carrying both risk genotypes (SS and 3/3) displayed a lower total weight loss during the program (p = 0.05). This effect derived mainly from difficulties in the weight maintenance phase (p = 0.11), while the weight reduction phase was not affected (p = 0.61). No influence was found in men (p = 0.93). Modulation of the serotonergic pathway by carrying both risk alleles seems to influence success of weight loss programs in women with severe obesity due to problems in stabilizing body weight after weight reduction.
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Affiliation(s)
- Dirk Wallmeier
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Julia K. Winkler
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Thomas Fleming
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Annika Woehning
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Katharina Huennemeyer
- />Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Eva Roeder
- />Institute of Food Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, SLA C94, Schorenstraße 16, 8603 Schwerzenbach, Switzerland
| | - Peter P. Nawroth
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- />Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Christian Wolfrum
- />Institute of Food Nutrition and Health, Swiss Federal Institute of Technology, ETH Zürich, SLA C94, Schorenstraße 16, 8603 Schwerzenbach, Switzerland
| | - Jobst-Hendrik Schultz
- />Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Gottfried Rudofsky
- />Department of Medicine I and Clinical Chemistry, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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20
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Abstract
Several lines of research have found that genes in the serotonergic system may cause susceptibility to eating disorders (EDs). In particular, functional polymorphisms of the serotonin transporter gene (5-HTT) have been suspected to play a role in the pathogenesis of eating disorders. Several studies have examined the association between the 5-HTTLPR polymorphism and bulimia nervosa (BN). The results of these investigations have been unclear. The aims of this meta-analysis were to clarify the association between BN and 5-HTTLPR using statistical models not used by previous meta-analyses, and extend upon previous meta-analyses by including new samples. PsychINFO, ISI, and PubMed databases were searched for studies published up to May 2011. Ultimately, six case-control samples were included. Data were pooled using dominant and additive models. Both models showed a nonsignificant association between the 5-HTTLPR polymorphism and BN. However, this does not detract from recent research suggesting that the 5-HTTLPR polymorphism may be responsible for the phenotypic variability in the psychopathological symptoms observed in patients with BN. Future research should examine the association of BN with 5-HTTLPR using the recently proposed triallelic model.
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21
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Mettler LN, Shott ME, Pryor T, Yang TT, Frank GK. White matter integrity is reduced in bulimia nervosa. Int J Eat Disord 2013; 46:264-73. [PMID: 23354827 PMCID: PMC3722416 DOI: 10.1002/eat.22083] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate brain white matter (WM) functionality in bulimia nervosa (BN) in relation to anxiety. METHOD Twenty-one control women (CW, mean age 27 ± 7 years) and 20 BN women (mean age 25 ± 5 years) underwent brain diffusion tensor imaging to measure fractional anisotropy (FA; an indication of WM axon integrity) and the apparent diffusion coefficient (ADC; reflecting WM cell damage). RESULTS FA was decreased in BN in the bilateral corona radiata extending into the posterior limb of the internal capsule, the corpus callosum, the right sub-insular WM, and right fornix. In CW but not BN, trait anxiety correlated negatively with fornix, corpus callosum, and left corona radiata FA. ADC was increased in BN compared with CW in the bilateral corona radiata, corpus callosum, inferior fronto-occipital, and uncinate fasciculus. Alterations in BN WM functionality were not due to structural brain alterations. DISCUSSION WM integrity is disturbed in BN, especially in the corona radiata, which has been associated with taste and brain reward processing. Whether this is a premorbid condition or an effect from the illness is yet uncertain. The relationships between WM FA and trait anxiety in CW but not BN may suggest that altered WM functionality contributes to high anxious traits in BN.
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Affiliation(s)
- Lisa N. Mettler
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan E. Shott
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Tony T. Yang
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Francisco, CA, USA,Department of Psychiatry, Division of Child and Adolescent Psychiatry, University of California, San Diego, CA, USA
| | - Guido K.W. Frank
- University of Colorado School of Medicine, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,Neuroscience Program, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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22
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Bailer UF, Frank GK, Price JC, Meltzer CC, Becker C, Mathis CA, Wagner A, Barbarich-Marsteller NC, Bloss CS, Putnam K, Schork NJ, Gamst A, Kaye WH. Interaction between serotonin transporter and dopamine D2/D3 receptor radioligand measures is associated with harm avoidant symptoms in anorexia and bulimia nervosa. Psychiatry Res 2013; 211:160-8. [PMID: 23154100 PMCID: PMC3880148 DOI: 10.1016/j.pscychresns.2012.06.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 06/25/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) have alterations of measures of serotonin (5-HT) and dopamine (DA) function, which persist after long-term recovery and are associated with elevated harm avoidance (HA), a measure of anxiety and behavioral inhibition. Based on theories that 5-HT is an aversive motivational system that may oppose a DA-related appetitive system, we explored interactions of positron emission tomography (PET) radioligand measures that reflect portions of these systems. Twenty-seven individuals recovered (REC) from eating disorders (EDs) (7 AN-BN, 11 AN, 9 BN) and nine control women (CW) were analyzed for correlations between [(11)C]McN5652 and [(11)C]raclopride binding. There was a significant positive correlation between [(11)C]McN5652 binding potential (BP(non displaceable(ND))) and [(11)C]Raclopride BP(ND) for the dorsal caudate, antero-ventral striatum (AVS), middle caudate, and ventral and dorsal putamen. No significant correlations were found in CW. [(11)C]Raclopride BP(ND), but not [(11)C]McN5652 BP(ND), was significantly related to HA in REC EDs. A linear regression analysis showed that the interaction between [(11)C]McN5652 BP(ND) and [(11)C]raclopride BP(ND) in the dorsal putamen significantly predicted HA. This is the first study using PET and the radioligands [(11)C]McN5652 and [(11)C]raclopride to show a direct relationship between 5-HT transporter and striatal DA D2/D3 receptor binding in humans, supporting the possibility that 5-HT and DA interactions contribute to HA behaviors in EDs.
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Affiliation(s)
- Ursula F. Bailer
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Medical University of Vienna, Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Vienna, Austria
| | - Guido K. Frank
- Department of Psychiatry, University of Colorado Denver, Children’s Hospital Colorado, Aurora, CO, USA,Department of Neuroscience, University of Colorado Denver; Anschutz Medical Campus, Aurora, CO, USA
| | - Julie C. Price
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Carolyn C. Meltzer
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA,University of Pittsburgh, School of Medicine, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA,Emory School of Medicine, Departments of Radiology, Neurology, and Psychiatry and Behavioral Sciences, Atlanta, Georgia, and Adjunct Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Carl Becker
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Chester A. Mathis
- University of Pittsburgh, School of Medicine, Department of Radiology, Presbyterian University Hospital, Pittsburgh, PA
| | - Angela Wagner
- University of California San Diego, Department of Psychiatry, La Jolla, CA
| | | | - Cinnamon S. Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute (STSI), and Scripps Health, La Jolla, CA
| | - Karen Putnam
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Nicholas J. Schork
- Department of Environmental Health, Division of Epidemiology and Biostatistics, University of Cincinnati, School of Medicine, Cincinnati, Ohio
| | - Anthony Gamst
- University of California San Diego, Department of Biostatistics and Bioinformatics, La Jolla, CA
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla, CA,Corresponding author: Walter H. Kaye, M.D., University of California, San Diego, UCSD Department of Psychiatry, 8950 Villa La Jolla Drive, Suite C – 207, La Jolla, California 92037, Tel. (858) 534 3951, FAX: (858) 534 6727,
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23
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Thaler L, Groleau P, Badawi G, Sycz L, Zeramdini N, Too A, Israel M, Joober R, Bruce KR, Steiger H. Epistatic interactions implicating dopaminergic genes in bulimia nervosa (BN): relationships to eating- and personality-related psychopathology. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:120-8. [PMID: 22683321 DOI: 10.1016/j.pnpbp.2012.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/16/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
We explored the influence of interactions between polymorphisms acting upon postsynaptic receptors (DRD2 TaqA1 rs1800497 and DRD4 7R) and dopamine regulators (COMT rs4680 and DAT1) on the expression of eating symptoms and personality traits in women with bulimia-spectrum eating disorders. We had 269 bulimic women provide blood for genetic assays, and measured eating-disorder symptoms and psychopathological traits using structured interviews and self-report questionnaires. We observed two epistatic interactions on symptom indices: interactions (in predicted directions) of DRD2 by DAT were seen on Body Mass Index (p=.023), and of DRD4 by COMT on self-harming behaviors (p=.014)--with genetic effects that would correspond to reduced dopamine transmission coinciding with more-pathological scores. Our findings suggest that genes acting in the dopamine system interact to influence both eating-related and personality psychopathology, with the result that lower levels of dopamine neuro-transmission correspond to increased psychopathology and body mass in women with bulimia-spectrum disorders. We discuss the implications of our observations.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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24
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Frank GK, Kaye WH. Current status of functional imaging in eating disorders. Int J Eat Disord 2012; 45:723-36. [PMID: 22532388 PMCID: PMC3872533 DOI: 10.1002/eat.22016] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2012] [Indexed: 11/11/2022]
Abstract
Eating Disorders are complex psychiatric problems that involve biologic and psychological factors. Brain imaging studies provide insights about how functionally connected brain networks may contribute to disturbed eating behavior, resulting in food refusal and altered body weight, but also body preoccupations and heightened anxiety. In this article, we review the current state of brain imaging in eating disorders, and how such techniques may help identify pathways that could be important in the treatment of those often detrimental disorders.
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Affiliation(s)
- Guido K.W. Frank
- University of Colorado Denver, Departments of Child & Adolescent Psychiatry and Neuroscience, Aurora CO
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla CA
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25
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Groleau P, Steiger H, Joober R, Bruce KR, Israel M, Badawi G, Zeramdini N, Sycz L. Dopamine-system genes, childhood abuse, and clinical manifestations in women with Bulimia-Spectrum Disorders. J Psychiatr Res 2012; 46:1139-45. [PMID: 22733030 DOI: 10.1016/j.jpsychires.2012.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We explored interaction effects involving polymorphisms of targeted dopamine system genes and selected forms of childhood abuse (sexual, physical and emotional) acting upon severity of binge-eating and psychopathological symptoms in women with Bulimia-Spectrum Disorders (BSDs). METHODS Women diagnosed with a BSD (n = 216) were assessed for childhood traumata, eating-disorder (ED) symptoms, and selected psychopathological features (sensation seeking, impulsivity, compulsivity and affective instability), and then provided blood samples for genotyping of main polymorphisms of dopamine-2 receptor (DRD2), dopamine transporter (DAT1) and catechol o-methyltransferase (COMT) genes. RESULTS Sensation Seeking was elevated in carriers of the low-function allele of the DRD2 Taq1A polymorphism who also reported childhood sexual abuse, relative to that in individuals showing other combinations of alleles and abuse exposures. In addition, carriers of a low-function allele of COMT scored higher on compulsivity, lower on impulsivity, and marginally lower on frequency of binge-eating than did individuals in whom the allele was absent. DISCUSSION Our results suggest that genes acting within the dopamine system may contribute, either directly or indirectly (i.e., in interaction with traumatic childhood experiences), to variations in the presentation of comorbid traits and, possibly, of bulimic symptoms.
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Affiliation(s)
- Patricia Groleau
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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26
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Dichter GS, Damiano CA, Allen JA. Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings. J Neurodev Disord 2012; 4:19. [PMID: 22958744 PMCID: PMC3464940 DOI: 10.1186/1866-1955-4-19] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/02/2012] [Indexed: 02/07/2023] Open
Abstract
This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette's syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies.
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Affiliation(s)
- Gabriel S Dichter
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina School of Medicine, CB# 7255, 101 Manning Drive, Chapel Hill, NC, 275997255, USA
| | - Cara A Damiano
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John A Allen
- Neuroscience Research Unit Pfizer Global Research and Development, Groton, CT 06340, USA
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27
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Castellini G, Ricca V, Lelli L, Bagnoli S, Lucenteforte E, Faravelli C, Sorbi S, Nacmias B. Association between serotonin transporter gene polymorphism and eating disorders outcome: a 6-year follow-up study. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:491-500. [PMID: 22488946 DOI: 10.1002/ajmg.b.32052] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 03/21/2012] [Indexed: 11/07/2022]
Abstract
Eating disorder patients show different long-term outcomes, and trait-related alterations of serotonergic function, which might be related with the serotonin transporter (5-HTT) gene. We studied the relationships between 5-HTTLPR polymorphism, eating specific and general psychopathology and the long-term outcome of anorexia nervosa (AN) and bulimia nervosa (BN) patients. We evaluated the distribution of the functional 5-HTTLPR polymorphism in a series of 201 Italian, Caucasian, eating disorder patients (113 with AN and 88 with BN binge/purging (BP subtype) and in 150 Caucasian unrelated controls. Prior to starting an individual cognitive behavior therapy, a clinical assessment was performed by means of the structured clinical interview for DSM-IV axis I disorders and several self-report questionnaires. This assessment was repeated at the end of treatment, 3 years after the end of treatment and 3 years after the first follow-up. Diagnostic changes between AN and BN were frequent (28.3%), and the presence of depressive disorders was associated with a higher rate of diagnostic crossover during the follow-up period. The S-allele of the 5-HTTLPR genotype increases the risk susceptibility for both depressive comorbidity (OR = 4.23; 95% CI, 1.45-12.37) and diagnostic crossover during the follow-up period in AN patients (OR = 5.04; 95% CI, 1.69-14.98). Logistic regression analyses confirmed these findings, when the interaction between genotype and psychiatric comorbidity as predictors of diagnostic instability in AN patients were taken into account. No significant association was found between 5-HTTLPR genotype and recovery. The S-allele of the 5-HTTLPR genotype increases the risk for depressive disorders comorbidity, and moderates the long-term outcome of anorectic patients.
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Affiliation(s)
- Giovanni Castellini
- Department of Neurological and Psychiatric Sciences, University of Florence, Largo Brambilla, Florence, Italy
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28
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Abstract
The high prevalence of substance abuse in individuals with bulimia nervosa (BN) and the pervasive symptom substitution in many types of drug addiction suggest that a number of substances--including food--can impair an individual's self-control, even in the presence of negative consequences. Nonetheless, the neurobiological similarities between BN and drug addiction are not clearly established. This review explores how the specific eating patterns seen in BN (binge eating and purging, with intermittent dietary restriction) are particularly addictive and differentiate BN from other eating disorders and obesity. A number of peripheral and central biological aberrations seen in BN may result in altered reward sensitivity in these individuals, particularly through effects on the dopaminergic system. Neurobiological findings support the notion that BN is an addictive disorder, which has treatment implications for therapy and pharmacological manipulations.
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29
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Frank GKW. Advances in the diagnosis of anorexia nervosa and bulimia nervosa using brain imaging. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2012; 6:235-244. [PMID: 22936952 PMCID: PMC3427937 DOI: 10.1517/17530059.2012.673583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION: Anorexia and bulimia nervosa are severe psychiatric disorders and the availability of brain imaging techniques hold promise that those techniques will be useful in clinical practice. AREAS COVERED: In this review I describe currently available brain imaging techniques and focus on the brain imaging methods functional magnetic resonance imaging (fMRI) and positron emission tomography (PET). Those techniques have helped describe alterations in brain circuitry in AN and BN that related to anxiety and reward processing. Novel computational models help further define brain function in relation to particular neurotransmitters. EXPERT OPINION: Brain imaging techniques are exciting methods to learn about brain function and progress has been made to identify in healthy populations brain circuits that code behaviors. These techniques have been used in AN and BN over the past decade and have improved our understanding of brain function in those disorders. Still, human brain imaging is not at a point yet where it could be used diagnostically. However, with the refinement of imaging hardware as well as improved models that describe brain function we will get closer to our aims to not only better understand the neurobiology of those disorders, but predict illness development, treatment response and long term prognosis.
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Affiliation(s)
- Guido K W Frank
- Departments of Psychiatry and Neuroscience, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Gary Pavilion A036/B-130, 13123 East 16th Avenue, Aurora, CO 80045, Tel.: 720-777-1909
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Pichika R, Buchsbaum MS, Bailer U, Hoh C, DeCastro A, Buchsbaum BR, Kaye W. Serotonin transporter binding after recovery from bulimia nervosa. Int J Eat Disord 2012; 45:345-52. [PMID: 21671458 PMCID: PMC3175264 DOI: 10.1002/eat.20944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Physiological and pharmacological studies indicate that altered brain serotonin (5-HT) activity could contribute to a susceptibility to develop appetitive and behavioral alterations that are characteristic of bulimia nervosa (BN). METHOD Eight individuals recovered from BN (REC BN) and eight healthy control women were scanned with [11C]DASB and positron emission tomography imaging of the 5-HT transporter (5-HTT). Logan graphical analysis was applied, and parametric binding potential (BP(nondisplaceable (ND)) ) images were generated. Voxel-by-voxel t-tests and a region of interest (ROI) analysis were conducted. RESULTS REC BN had significantly lower [11C]DASB BP(ND) in midbrain, superior and inferior cingulate and significantly higher [11C]DASB BP(ND) in anterior cingulate and superior temporal gyrus in the voxel-based analysis. ROI analysis indicated lower [11C]DASB BP(ND) in midbrain (p = .07), containing the dorsal raphe, in REC BN, consistent with our earlier studies. DISCUSSION These preliminary findings of a small-scale study confirm and extend previous data suggesting that ill and recovered BN have altered 5-HTT measures, which potentially contribute to BN symptomatology and/or differential responses to medication.
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Affiliation(s)
- Rama Pichika
- Department of Radiology, University of California, San Diego
| | - Monte S. Buchsbaum
- Department of Psychiatry, University of California, San Diego
- Department of Radiology, University of California, San Diego
| | - Ursula Bailer
- Department of Psychiatry, University of California, San Diego
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Carl Hoh
- Department of Radiology, University of California, San Diego
| | - Alex DeCastro
- Department of Psychiatry, University of California, San Diego
- Department of Radiology, University of California, San Diego
| | | | - Walter Kaye
- Department of Psychiatry, University of California, San Diego
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Abstract
Current diagnostic criteria for anorexia nervosa (AN) and bulimia nervosa (BN) account for a minority of individuals with clinically significant disorders of eating, raising concerns about the clinical utility of current definitions. This review examines evidence for the validity of current and alternative approaches to defining eating disorders and implications for draft criteria for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Although this review largely supports the predictive validity of distinctions among AN, BN, and the newly proposed binge eating disorder (BED), it also highlights that our tendency to "study what we define" has created a gap between the problems that people have and what we know about those problems. Future research on the causes and consequences of eating disorders should include more heterogeneous groups to enable identification of meaningful boundaries that distinguish between disorders based on etiological and predictive validity.
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Affiliation(s)
- Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida 32306, USA.
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Frank GK, Reynolds JR, Shott ME, O’Reilly RC. Altered temporal difference learning in bulimia nervosa. Biol Psychiatry 2011; 70:728-735. [PMID: 21718969 PMCID: PMC3186835 DOI: 10.1016/j.biopsych.2011.05.011] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/05/2011] [Accepted: 05/12/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND The neurobiology of bulimia nervosa (BN) is poorly understood. Recent animal literature suggests that binge eating is associated with altered brain dopamine (DA) reward function. In this study, we wanted to investigate DA-related brain reward learning in BN. METHODS Ill BN (n = 20, age: mean = 25.2, SD = 5.3 years) and healthy control women (CW) (n = 23, age: mean = 27.2, SD = 6.4 years) underwent functional magnetic resonance brain imaging together with application of a DA-related reward learning paradigm, the temporal difference (TD) model. That task involves association learning between conditioned visual and unconditioned taste stimuli, as well as unexpected violation of those learned associations. Study participants also completed the Sensitivity to Reward and Punishment Questionnaire. RESULTS Bulimia nervosa individuals showed reduced brain response compared with CW for unexpected receipt and omission of taste stimuli, as well as reduced brain regression response to the TD computer model generated reward values, in insula, ventral putamen, amygdala, and orbitofrontal cortex. Those results were qualitatively similar in BN individuals who were nondepressed and unmedicated. Binge/purge frequency in BN inversely predicted reduced TD model response. Bulimia nervosa individuals showed significantly higher Sensitivity to Reward and Punishment compared with CW. CONCLUSIONS This is the first study that relates reduced brain DA responses in BN to the altered learning of associations between arbitrary visual stimuli and taste rewards. This attenuated response is related to frequency of binge/purge episodes in BN. The brain DA neurotransmitter system could be an important treatment target for BN.
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Affiliation(s)
- Guido K.W. Frank
- Department of Psychiatry, University of Colorado Denver, The Children’s Hospital, Aurora, CO80045, USA, Department of Neuroscience, University of Colorado Denver; Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Megan E. Shott
- Department of Psychiatry, University of Colorado Denver, The Children’s Hospital, Aurora, CO80045, USA
| | - Randall C. O’Reilly
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
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Abstract
Abstract
Objectives
The purpose of this review is to outline the nosographic characteristics of NES and the most reliable ethiopathogenetic theories in relation to the most recent evidence in the literature.
Key findings
The night eating syndrome (NES) is a disorder occurring at the stated time, that does not meet the criteria for any specific eating disorder. NES is characterized by a reduced feeding during the day, evening hyperphagia accompanied by frequent nocturnal awakenings associated with conscious episodes of compulsive ingestion of food and abnormal circadian rhythms of food and other neuroendocrine factors. Frequently it is associated with obesity and depressed mood. We highlight the therapeutic possibilities of some drugs, especially selective serotonin re-uptake inhibitors (SSRIs), which reduce the hyperactivity of the serotonin transporter in NES and significantly improve the clinical picture of this disease.
Conclusions
Night eating syndrome is of importance clinically because of its association with obesity. The recognition and effective treatment of NES may be an increasingly important way to treat a subset of the obese population. Treatment of the syndrome, however, is still in its infancy. One clinical trial has reported efficacy with the SSRI sertraline. Other treatments, such as the anticonvulsant topiramate, phototherapy, and other SSRIs, may also offer future promise. Particularly useful would be studies involving brain scans (magnetic resonance imaging or single-photon emission computed tomography) of patients with NES compared with the healthy population, to investigate more thoroughly the possible alterations involved in the pathogenesis of NES.
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Affiliation(s)
- Walter Milano
- Mental Health Unit, Distretto 24, ASL Napoli 1 Centro, Naples, Italy
| | - Michele De Rosa
- Mental Health Unit, Distretto 24, ASL Napoli 1 Centro, Naples, Italy
| | - Luca Milano
- Mental Health Unit, Distretto 24, ASL Napoli 1 Centro, Naples, Italy
| | - Anna Capasso
- Department of Pharmaceutical and Biomedical Science, University of Salerno, Italy
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Bulimia nervosa and evidence for striatal dopamine dysregulation: a conceptual review. Physiol Behav 2011; 104:122-7. [PMID: 21549135 DOI: 10.1016/j.physbeh.2011.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This article reviews concepts and evidence, based in particular on the work of Bartley G. Hoebel and colleagues, which suggest that a better understanding of the role of striatal dopamine (DA) in the initiation and/or maintenance of bulimia nervosa (BN) may result in a clearer characterization of mechanisms underlying BN. METHODS Literature review, using PubMed search. RESULTS Several lines of evidence, including the work of Bartley G. Hoebel, implicate the importance of striatal DA in feeding behavior, as well as in the disordered eating behaviors relevant to BN. Preclinical models of 'BN-like' eating behaviors have been associated with changes in striatal DA and DA receptor measures. Emerging clinical research also suggests that striatal DA abnormalities exist in individuals with BN. CONCLUSION Alterations in striatal DA may exist in patients with BN. While the precise relationship between these findings and the etiology and maintenance of bulimic symptomatology remains unclear, further investigation of brain DA systems is a fruitful avenue of future research in BN.
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior, weight regulation, and disturbances in attitudes and perceptions toward body weight and shape. Several lines of evidence nominate disturbances of serotonin (5-HT) pathways as playing a role in the pathogenesis and pathophysiology of AN and BN. For example, 5-HT pathways are known to contribute to the modulation of a range of behaviors commonly seen in individuals with AN and BN. New technology using brain imaging with radioligands offers the potential for understanding previously inaccessible brain 5-HT neurotransmitter function and its dynamic relationship with human behaviors. Recent studies using positron emission tomography and single photon emission computed tomography with 5-HT-specific radioligands have consistently shown 5-HT(1A) and 5-HT(2A) receptor and 5-HT transporter alterations in AN and BN in cortical and limbic structures, which may be related to anxiety, behavioral inhibition, and body image distortions. These disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Effective treatments for AN and BN have been elusive. A better understanding of neurobiology is likely to be important for developing specific and more powerful therapies for these often chronic and deadly disorders.
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Affiliation(s)
- Ursula F Bailer
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria
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Lee Y, Lin PY. Association between serotonin transporter gene polymorphism and eating disorders: a meta-analytic study. Int J Eat Disord 2010; 43:498-504. [PMID: 19708070 DOI: 10.1002/eat.20732] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Compelling evidence has suggested a role for serotonin system dysfunction in the pathogenesis of eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN). Studies have examined the association between EDs and a functional polymorphism of the serotonin transporter gene promoter (5-HTTLPR). These studies have yielded inconsistent results. The present study aimed to determine conclusively whether there is an association by using a meta-analytic method. METHOD Data of over 2,000 participants from eight independent case-controlassociation studies were pooled by using a random effects model. RESULTS AN was found to be significantly associated with the S allele (p < .001) and S carrier (SS + LS) genotype (p = .007). However, BN was associated neither with the S allele (p = .49) nor with the S carrier genotype (p = .33). DISCUSSION These results suggested that the genetic variance of the serotonin transporter gene promoter contributed to the susceptibility of AN.
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Affiliation(s)
- Yu Lee
- Department of Psychiatry, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Hildebrandt T, Alfano L, Tricamo M, Pfaff DW. Conceptualizing the role of estrogens and serotonin in the development and maintenance of bulimia nervosa. Clin Psychol Rev 2010; 30:655-68. [PMID: 20554102 DOI: 10.1016/j.cpr.2010.04.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 04/24/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
Serotonergic dysregulation is thought to underlie much of the pathology in bulimia nervosa (BN). The purpose of this review is to expand the serotonergic model by incorporating specific and nonspecific contributions of estrogens to the development and maintenance of bulimic pathology in order to guide research from molecular genetics to novel therapeutics for BN. Special emphasis is given to the organizing theory of general brain arousal which allows for integration of specific and nonspecific effects of these systems on behavioral endpoints such as binge eating or purging as well as arousal states such as fear, novelty seeking, or sex. Regulation of the serotonergic system by estrogens is explored, and genetic, epigenetic, and environmental estrogen effects on bulimic pathology and risk factors are discussed. Genetic and neuroscientific research support this two-system conceptualization of BN with both contributions to the developmental and maintenance of the disorder. Implications of an estrogenic-serotonergic model of BN are discussed as well as guidelines and suggestions for future research and novel therapeutic targets.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA.
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Dopamine and binge eating behaviors. Pharmacol Biochem Behav 2010; 97:25-33. [PMID: 20417658 DOI: 10.1016/j.pbb.2010.04.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 03/23/2010] [Accepted: 04/19/2010] [Indexed: 01/15/2023]
Abstract
Central dopaminergic mechanisms are involved in the motivational aspects of eating and food choices. This review focuses on human and animal data investigating the importance of dopamine on binge eating behaviors. Early work examining dopamine metabolites in the cerebrospinal fluid and plasma of bulimic individuals suggested decreased dopamine turnover during the active phase of the illness. While neuroimaging studies of dopamine mechanisms in bulimia nervosa (BN) and binge eating disorder (BED) are limited, genetic studies in humans have implicated an increased frequency of dopamine transporter and associated D2 receptor polymorphisms with binge pathology. Recent studies in rodent models of dietary-induced binge eating (DIBE) have investigated plausible dopamine mechanisms involved in sustaining binge eating behaviors. In DIBE models, highly palatable foods (fats, sugars and their combination), as well as restricted access conditions appear to promote ingestive responses and result in sustained dopamine stimulation within the nucleus accumbens. Taken together with studies on the comorbidity of illicit drug use and eating disorders, the data reviewed here support a role for dopamine in perpetuating the compulsive feeding patterns of BN and BED. As such, we propose that sustained stimulation of the dopamine systems by bingeing promoted by preexisting conditions (e.g., genetic traits, dietary restraint, stress, etc.) results in progressive impairments of dopamine signaling. To disrupt this vicious cycle, novel research-based treatment options aiming at the neural substrates of compulsive eating patterns are necessary.
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Abstract
This paper considers possible mechanisms for the Night Eating Syndrome (NES). NES is a disorder characterized by a delay in the circadian rhythm of meals and of several neuroendocrine factors. The disorder occurs in genetically vulnerable people when exposed to stress. No convincing mechanism of the NES has been reported until now. To search for the mechanisms of NES, the long term treatment of two highly perceptive patients with rapid onset of the disorder are described. Disruption of three neuroendocrine systems compatible with these histories are discussed: the glucocorticoid system, the melanocortin [corrected] system, and the serotonergic system. Current evidence favors the serotonergic system and this view is strongly supported by the great effectiveness of selective serotonin reuptake inhibitors (SSRIs) in the treatment of NES.
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Affiliation(s)
- A Stunkard
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Steiger H, Bruce KR, Groleau P. Neural circuits, neurotransmitters, and behavior: serotonin and temperament in bulimic syndromes. Curr Top Behav Neurosci 2010; 6:125-38. [PMID: 21107929 DOI: 10.1007/7854_2010_88] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In bulimia nervosa (BN), and in related binge-purge syndromes, factors affecting central serotonin (5-hydroxytryptamine, 5-HT) function appear to contribute not only to appetitive dysregulation but also to temperamental and personality manifestations. Drawing upon findings from neurobiological, molecular-genetic, and brain-imaging studies, we present an integrative model of the role of 5-HT function in bulimic syndromes. At the core of our model is a consideration of the ways in which diverse hereditary and environmental influences impact the action of the 5-HT system. We believe that our model helps account for heterogeneous traits seen in the bulimic population, for disproportionate representation of individuals displaying pathological personality traits and exposure to severe environmental stressors, and for interindividual variations as to treatment response.
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Affiliation(s)
- Howard Steiger
- Douglas University Institute, 6875 LaSalle Blvd, Montreal (Verdun), QC, Canada, H4H 1R3.
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Zitterl W, Stompe T, Aigner M, Zitterl-Eglseer K, Ritter K, Zettinig G, Hornik K, Asenbaum S, Pirker W, Thau K. Diencephalic serotonin transporter availability predicts both transporter occupancy and treatment response to sertraline in obsessive-compulsive checkers. Biol Psychiatry 2009; 66:1115-22. [PMID: 19717141 DOI: 10.1016/j.biopsych.2009.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 07/01/2009] [Accepted: 07/14/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND To our knowledge, no studies have investigated the predictive value of central serotonin transporter (SERT) availability for treatment response to serotonin reuptake inhibitors (SSRIs) in patients with obsessive-compulsive disorder (OCD). This study used brain imaging to examine the relationship between pretreatment SERT availability and transporter occupancy as well as treatment response by sertraline in patients displaying prominent behavioral checking compulsions (OC checkers). METHODS Single photon emission computed tomography (SPECT) was used to measure thalamic-hypothalamic SERT availability with [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane in 28 nondepressed OC checkers at baseline and after 14 weeks of treatment with sertraline (175 mg daily). SERT availability was correlated with OC severity and treatment response as assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Associations between individual transporter occupancies and clinical parameters were investigated. RESULTS 1) Correlation analyses between thalamic-hypothalamic SERT availability and OC severity showed significant negative associations at baseline and after treatment with sertraline. 2) Pretreatment SERT availability correlated significantly with both transporter occupancy and treatment response; in addition, a positive association was found between transporter occupancy and treatment response directly. 3) Using multivariate statistical models, the data demonstrated that higher pretreatment SERT availability significantly predicted higher occupancy rates as well as better treatment response 14 weeks later. CONCLUSIONS Higher pretreatment thalamic-hypothalamic SERT availability may predict both higher occupancy rates and better treatment response to sertraline. The data suggest a strong connection between transporter occupancy and treatment response.
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Affiliation(s)
- Werner Zitterl
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria.
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Abstract
This paper will propose a biobehavioral mechanism for the Night Eating Syndrome (NES), a disorder characterized by a delayed circadian rhythm of food intake and neuroendocrine function. Food intake consists of at least 25% of daily caloric intake after the evening meal and/or at least two nighttime awakenings with ingestions per week. This will be explored by reviewing neuroimaging of brain serotonin transporters (SERT) and treatment with selective serotonin reuptake inhibitors (SSRIs). SERT binding is elevated in the midbrain of night eaters, causing dysregulation of the circadian rhythm of both food intake and neuroendocrine function. The administration of SSRIs blocks the reuptake of serotonin and restores the circadian rhythm of both food intake and neuroendocrine function. This hypothesis implies that reduction of SERT activity should increase postsynaptic serotonin transmission and relieve NES. This is precisely the effect of SSRIs. NES is a function of elevated SERT, and blocking of SERT with an SSRI resolves NES. This model of NES attests to the validity of the diagnosis of NES and the criteria by which it is identified, and it provides an explanation of the mechanism.
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Affiliation(s)
- A J Stunkard
- School of Medicine, Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia, Pennsylvania 19104-3309, USA.
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Steiger H, Richardson J, Schmitz N, Joober R, Israel M, Bruce KR, Gauvin L, Dandurand C, Anestin A. Association of trait-defined, eating-disorder sub-phenotypes with (biallelic and triallelic) 5HTTLPR variations. J Psychiatr Res 2009; 43:1086-94. [PMID: 19383563 DOI: 10.1016/j.jpsychires.2009.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/12/2009] [Accepted: 03/17/2009] [Indexed: 12/16/2022]
Abstract
CONTEXT Efforts to classify eating-disordered individuals based on concurrent personality traits have consistently converged on a typology encompassing "over-regulated", "dysregulated", and "low psychopathology" subgroups. In various populations, evidence has associated personality variations of an "over-regulated/dysregulated" type with differences on serotonin-system indices, and specifically, with different loadings of serotonin transporter promoter regulatory region polymorphism (5HTTLPR) genotypes and alleles. We explored the extent to which an empirical, trait-defined typology of eating-disordered individuals coincided systematically with variations in 5HTTLPR, assayed using biallelic and triallelic models. METHOD We tested 185 women with a DSM-IV eating disorder (108 with Bulimia Nervosa, 17 Anorexia Nervosa, and 60 an Eating Disorder Not Otherwise Specified) and 93 with no eating disorder on measures reflecting psychopathological traits and 5HTTLPR (biallelic and triallelic) genotypes and alleles. RESULTS The highest-function, triallelic (L(A)/L(A)) genotype occurred significantly more frequently among eating-disordered individuals than among controls. However, a more fine-grained analysis suggested that this association was attributable to the fact that, among eating-disordered participants, those displaying an "Inhibited/Compulsive" profile (derived using latent class analysis) were more likely than those of a "Dissocial/Impulsive" or a "Low Psychopathology" group to carry the triallelic 5HTTLPR gain-of-function L(A) allele and to be L(A)/L(A) homozygotes. DISCUSSION This study's empirically derived classes coincide with interpretable differences on genetic indices-associating an "Inhibited/Compulsive" group with 5HTTLPR gain-of-function genotypes (and alleles) that have elsewhere been linked to trait compulsivity. The findings, furthermore, suggest that 5HTTLPR, by influencing personality-trait manifestations may, in turn, influence eating-disorder risk and symptom expression.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute in Mental Health, Quebec, Canada.
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Marsh R, Steinglass JE, Gerber AJ, Graziano O'Leary K, Wang Z, Murphy D, Walsh BT, Peterson BS. Deficient activity in the neural systems that mediate self-regulatory control in bulimia nervosa. ACTA ACUST UNITED AC 2009; 66:51-63. [PMID: 19124688 DOI: 10.1001/archgenpsychiatry.2008.504] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Disturbances in neural systems that mediate voluntary self-regulatory processes may contribute to bulimia nervosa (BN) by releasing feeding behaviors from regulatory control. OBJECTIVE To study the functional activity in neural circuits that subserve self-regulatory control in women with BN. DESIGN We compared functional magnetic resonance imaging blood oxygenation level-dependent responses in patients with BN with healthy controls during performance of the Simon Spatial Incompatibility task. SETTING University research institute. PARTICIPANTS Forty women: 20 patients with BN and 20 healthy control participants. Main Outcome Measure We used general linear modeling of Simon Spatial Incompatibility task-related activations to compare groups on their patterns of brain activation associated with the successful or unsuccessful engagement of self-regulatory control. RESULTS Patients with BN responded more impulsively and made more errors on the task than did healthy controls; patients with the most severe symptoms made the most errors. During correct responding on incongruent trials, patients failed to activate frontostriatal circuits to the same degree as healthy controls in the left inferolateral prefrontal cortex (Brodmann area [BA] 45), bilateral inferior frontal gyrus (BA 44), lenticular and caudate nuclei, and anterior cingulate cortex (BA 24/32). Patients activated the dorsal anterior cingulate cortex (BA 32) more when making errors than when responding correctly. In contrast, healthy participants activated the anterior cingulate cortex more during correct than incorrect responses, and they activated the striatum more when responding incorrectly, likely reflecting an automatic response tendency that, in the absence of concomitant anterior cingulate cortex activity, produced incorrect responses. CONCLUSIONS Self-regulatory processes are impaired in women with BN, likely because of their failure to engage frontostriatal circuits appropriately. These findings enhance our understanding of the pathogenesis of BN by pointing to functional abnormalities within a neural system that subserves self-regulatory control, which may contribute to binge eating and other impulsive behaviors in women with BN.
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Affiliation(s)
- Rachel Marsh
- Department of Psychiatry, New York State Psychiatric Institute and the College of Physicians and Surgeons, Columbia University, New York, New York.
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Van den Eynde F, Treasure J. Neuroimaging in eating disorders and obesity: implications for research. Child Adolesc Psychiatr Clin N Am 2009; 18:95-115. [PMID: 19014860 DOI: 10.1016/j.chc.2008.07.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Medicine and psychiatry have benefited from developments in investigational techniques. Neuroimaging is one such domain that has technically progressed enormously in recent years, resulting in, for example, higher temporal and spatial resolution. Neuroimaging techniques have been widely used in a range of psychiatric disorders, providing new insights into neural brain circuits and neuroreceptor functions in vivo. These imaging techniques allow researchers to study not only the configuration of brain structures but also aspects of normal and anomalous human behavior more accurately.
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Affiliation(s)
- Frederique Van den Eynde
- Institute of Psychiatry, Section of Eating Disorders PO59, De Crespigny Park, SE5 8AF, London, UK
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Crow SJ, Mitchell JE, Roerig JD, Steffen K. What potential role is there for medication treatment in anorexia nervosa? Int J Eat Disord 2009; 42:1-8. [PMID: 18683884 DOI: 10.1002/eat.20576] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review selected issues regarding the development of drug treatments for anorexia nervosa (AN). METHOD The existing pharmacotherapy literature for AN is reviewed, and the theoretical and practical considerations are discussed. RESULTS A very wide variety of drugs have been examined in AN, generally with negative results. There are a number of potential reasons for this finding, including compliance, nutritional deficits, selection of the wrong targets or the wrong outcome measures, use of monotherapy, lack of animal models, or factors intrinsic to AN. CONCLUSION Pharmacotherapy provides little benefit in the treatment of AN at present. Several strategies might lead to the identification of more effective agents, including new measurement strategies, identification of novel pharmacologic targets, and consideration of a clinical trials network.
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Affiliation(s)
- Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454-1495, USA.
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Wöckel L, Zepf FD, Koch S, Meyer-Keitel AE, Schmidt MH. Serotonin-induced decrease of intracellular Ca(2+) release in platelets of bulimic patients normalizes during treatment. J Neural Transm (Vienna) 2008; 116:89-95. [PMID: 19082524 DOI: 10.1007/s00702-008-0163-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 11/18/2008] [Indexed: 12/01/2022]
Abstract
Numerous symptoms related to eating disorders have been shown to be influenced by serotonergic (5-HT) functioning, with the 5-HT(2A) receptor subtype being one of the most relevant involved in the pathophysiology of bulimia nervosa (BN). In line with this, Ca(2+) mobilization as mediated by 5-HT(2) receptors in platelets was shown to serve as a peripheral model for central nervous 5-HT functioning. Here, the 5-HT-induced intracellular Ca(2+) mobilization in platelets was measured in 13 female normal weight bulimic patients (14-18 years) upon admission and at the end of inpatient treatment. Findings were compared to 21 age-matched healthy female adolescents. 5-HT-induced Ca(2+) release was significantly decreased in bulimic patients upon admission and normalized during inpatient treatment. Antidepressive medication caused a significant improvement. The data provide further evidence that altered 5-HT(2) receptor functioning is involved in the pathophysiological underpinnings in BN.
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Affiliation(s)
- Lars Wöckel
- Department of Child and Adolescent Psychiatry and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, 52074, Aachen, Germany.
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Changes in thalamus-hypothalamus serotonin transporter availability during clomipramine administration in patients with obsessive-compulsive disorder. Neuropsychopharmacology 2008; 33:3126-34. [PMID: 18354388 DOI: 10.1038/npp.2008.35] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To the authors' knowledge there is as of yet no study demonstrating in vivo alterations in human serotonin transporters (SERT) during clomipramine treatment in patients with obsessive-compulsive disorder. The only study in which SERT binding has been investigated in obsessive-compulsive disorder (OCD) patients before and after treatment is a small pilot study by Stengler-Wenzke et al (2006), who treated five OCD patients with citalopram. In the study at hand, we measured transporter availability in the thalamus-hypothalamus with [(123)I] beta-CIT single photon emission computed tomography (SPECT) in 24 patients with DSM-IV OCD. All patients displayed prominent behavioral checking compulsions (OC-checkers). At baseline and upon medication after 12 weeks of treatment with clomipramine (150 mg daily) 24 non-depressed OC-checkers underwent a SPECT measurement of brain SERT availability using [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [(123)I] beta-CIT brain binding was used (BP(ND)=(thalamus and hypothalamus-cerebellum)/cerebellum). The SERT availability was compared between baseline and after treatment and correlated with severity of OC symptomatology and treatment response as assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). After treatment with clomipramine patients showed a 48% reduced brain serotonin transporter availability in the thalamus-hypothalamus, as compared with values at baseline (0.72+/-0.12 vs 1.39+/-0.18, p<0.001). Correlations between brain SERT availability and OC symptomatology (Y-BOCS scores) revealed significantly negative associations both at baseline and after treatment (r=-0.46; p<0.05 and r=-0.53; p<0.01 respectively). These data suggest that the SERT availability values could be considered a biological indicator of disease severity. Moreover, in search of predictors we found that higher pretreatment SERT availability significantly predicted better treatment response 12 weeks later (B=14.145+/-4.514; t=3.133; p=0.005). These results provide further support for an important role of alterations in serotonergic neurons in the pathophysiology of OCD.
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Loudness dependence of auditory evoked potentials as indicator of central serotonergic neurotransmission: simultaneous electrophysiological recordings and in vivo microdialysis in the rat primary auditory cortex. Neuropsychopharmacology 2008; 33:3176-81. [PMID: 18463629 DOI: 10.1038/npp.2008.42] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Serotonin released in synapsis is one of the key neurotransmitters in psychiatry and psychopharmacology. The loudness dependence of auditory evoked potentials (LDAEP) has been proposed as a marker for central serotonergic neurotransmission. Several findings in animals and humans support this hypothesis. However, the in vivo measurement of cortical extracellular serotonin levels has never been performed simultaneously with the recording of auditory evoked potentials. The interrelationship between low cortical serotonergic activity and strong LDAEP is yet to be proven. The auditory evoked potentials were recorded in the epidura above the primary auditory cortex of male Wistar rats whereas extracellular serotonin levels in the primary auditory cortex were measured by in vivo microdialysis before and after i.p. application of the selective serotonin reuptake inhibitor citalopram. At baseline, the correlation of coefficients between the LDAEP, especially of the N1 component, and extracellular serotonin levels in the primary auditory cortex was negative. The increase of serotonin levels after citalopram application was significantly related to a decrease of LDAEP of the N1 component (r=-0.86, p=0.003). These data support the view that the LDAEP is closely modulated by cortical serotonergic activity. Thus, the LDAEP might serve as an inversely related marker of synaptically released serotonin in the CNS.
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